From the Department of Ophthalmology, Duke Eye Center, Duke University Medical Center (Wakil, Birnbaum, Vu, McBurney-Lin, and Tseng), Durham, North Carolina, USA; Department of Ophthalmology, University of Montreal, Montreal (Wakil), Quebec, Canada; Ocala Eye (ElMallah), Ocala, Florida, USA.
J Cataract Refract Surg. 2020 Oct;46(10):1408-1415. doi: 10.1097/j.jcrs.0000000000000263.
To compare the 18-month efficacy and safety of Kahook Dual Blade goniotomy (KDB) in combination with cataract surgery (combined group) or as a standalone procedure (standalone group).
Single surgeon practice.
Retrospective review study.
A total of 116 eyes of 100 patients underwent KDB by a single well-experienced surgeon from May 2016 to 2018. A total of 93 eyes and 23 eyes were in the combined and standalone groups, respectively. Main outcome measures were reduction in intraocular pressure (IOP) and IOP-lowering medication and adverse events. Data were collected and analyzed using Welch t tests in R.
A total of 116 eyes of 100 patients were included in the analysis. Moderate or severe glaucoma was observed in 71% of eyes in the combined group compared with 83% in the standalone group. At baseline, mean IOP was 16.5 ± 5.0 mm Hg (n = 93) and 24.3 ± 9.1 mm Hg (n = 23) in the combined and standalone groups, respectively (P < .05). The IOP decreased in both groups at 12 months (14.1 ± 3.9 vs 16.9 ± 7.6, P = .24) and 18 months (14.4 ± 3.7 vs 16.7 ± 7.6, P = .5). There was a statistically significant difference in the number of drops between the combined and standalone groups at baseline (2.4 ± 1.2 vs 2.9 ± 1.0, P < .05) persisting at 12 months (1.3 ± 1.2 vs 2.6 ± 1.2, P < .05) and at 18 months (1.3 ± 1.2 vs 3.3 ± 1.2, P < .05). Complications included transient hyphemas (20 eyes [17%]) and IOP spike (20 eyes [17%]). Seven eyes required additional glaucoma surgery, 5 of which were in the standalone group.
KDB was an effective and safe procedure for different glaucoma disease severities, whether combined with cataract surgery or as a standalone surgery. It is an alternative to consider prior to pursuing more invasive glaucoma surgeries.
比较 Kahook Dual Blade 前房角切开术（KDB）联合白内障手术（联合组）或作为独立手术（独立组）治疗的 18 个月疗效和安全性。
单外科医生手术。
回顾性研究。
2016 年 5 月至 2018 年，一位经验丰富的外科医生对 100 例患者的 116 只眼进行了 KDB。联合组和独立组分别有 93 只眼和 23 只眼。主要观察指标为眼压（IOP）降低和降眼压药物以及不良反应。数据使用 R 中的 Welch t 检验进行收集和分析。
共纳入 100 例患者的 116 只眼进行分析。联合组中 71%的眼为中度或重度青光眼，而独立组中 83%的眼为中度或重度青光眼。基线时，联合组和独立组的平均眼压分别为 16.5±5.0mmHg（n=93）和 24.3±9.1mmHg（n=23）（P<.05）。两组在 12 个月（14.1±3.9 比 16.9±7.6，P=.24）和 18 个月（14.4±3.7 比 16.7±7.6，P=.5）时 IOP 均下降。联合组和独立组在基线时的滴眼次数存在统计学差异（2.4±1.2 比 2.9±1.0，P<.05），在 12 个月时（1.3±1.2 比 2.6±1.2，P<.05）和 18 个月时（1.3±1.2 比 3.3±1.2，P<.05）仍存在差异。并发症包括一过性前房积血（20 只眼[17%]）和眼压升高（20 只眼[17%]）。7 只眼需要额外的青光眼手术，其中 5 只眼在独立组。
KDB 是一种有效且安全的治疗不同严重程度青光眼的方法，无论联合白内障手术还是作为独立手术。在考虑进行更具侵袭性的青光眼手术之前，这是一种可供选择的治疗方法。
